New Era University

No. 9 Central Ave., New Era, Quezon City

______________________________
Department

Date: __________________

Dear Sir / Madam:

The undersigned wishes to inform you that your child / ward __________________________________________
Name of Student
together with his / her classmates will undertake an off-campus activity on _______________________________
Date
at _________________________________________________. The purpose of this activity is ______________
Location
__________________________________________________________________________________________

In view of this, we wish to obtain your consent for him / her to join this activity by signing the waiver below.

Thank you.

Truly yours, If dorm resident:

____________________________ _______________________________
Teacher / Instructor SAO Director
_________________________________________________________________________________________
CONSENT

We / I, _________________________________________________________, parents/guardians of Elem. / High

Name of parent/guardian
School / College student, _____________________________________, Year & Section ___________________
Name of Student
Hereby affix our / my signature as a proof of our / my consent to our / my child’s joining the
____________________________________________ in ____________________________________________
Activity Location

We / I, hereby hold free and harmless New Era University, _________________________ and any of its officers,
Department / Branch
Teachers and staff in the event of any accident, injury or sickness that may befall our / my child in the course of
this activity knowing that the school shall and will exercise extraordinary diligence.

Signed this _______ of _______________________, ________ in _____________________________________

Day Month Year Place

_________________ _______________________________
Relation Signature over printed name

_________________________________________________________________________________________
CONSENT

We / I, _________________________________________________________, parents/guardians of Elem. / High

Name of parent/guardian
School / College student, _____________________________________, Year & Section ___________________
Name of Student
Hereby affix our / my signature as a proof of our / my consent to our / my child’s joining the
____________________________________________ in ____________________________________________
Activity Location

We / I, hereby hold free and harmless New Era University, _________________________ and any of its officers,
Department / Branch
Teachers and staff in the event of any accident, injury or sickness that may befall our / my child in the course of
this activity knowing that the school shall and will exercise extraordinary diligence.

Signed this _______ of _______________________, ________ in _____________________________________

Day Month Year Place

_________________ _______________________________
Relation Signature over printed name